The process of shared construction of stories based on narrative medicine applied to Primary Health Care

a case study

Abstract

Introduction: Some primary health care (PHC) users, despite proposed treatments and follow-up with health unit professionals, focal specialists, and multidisciplinary teams, feel dissatisfied and misunderstood in their suffering. However, knowledge has emerged about the potential of narratives in the context of medicine and narrative medicine (NM) has been described, which is practiced with the ability to deepen and honor patients’ stories. This approach improves satisfaction with health care and initiates a symbolic level of healing through attentive listening to the person’s story. Objective: To explore how NM can be a care tool applied to PHC for users who feel poorly understood in their illness process. Methods: This is a qualitative case study, submitted to and approved by the Ethics Committee in Research of Universidade Federal do Paraná (CEP-UFPR) and Plataforma Brasil, in the action research modality. A user was invited to participate in a qualitative semi-structured interview to produce narratives and better understand their suffering, based on the MINI questionnaire. After application, a narrative was written about the story told, read to the patient, printed, and delivered. The patient had a few weeks to reflect on the content, with subsequent feedback to evaluate the impact of the reading on her perspective. Results: The adoption of this methodology allowed for a deeper understanding of suffering and increased empathy on the part of the professional. For the user, an experience of understanding and trust was experienced, with the benefit of not having felt judged, as well as improved insight into her illness process. A simple, low-complexity tool for use in PHC was described. However, due to the use of reading and writing, there is a challenge in the educational inequality in Brazil. Narrative methods have been shown in the literature, especially in the field of psychology and narrative therapy, to be beneficial for treating complex contexts of suffering, such as post-traumatic stress disorder in refugees, adolescent victims of sexual violence, victims of natural disasters, and developing resilience in orphaned children. Conclusions: NM can be promising if applied in clinical practice, with benefits such as deepening the understanding of both professionals and patients about their illness process and nuances of suffering that a simple anamnesis cannot achieve. The production of narratives, followed by their delivery and reflection by both professionals and users, enhance and potentiates the integrality, coordination of care, and person-centered clinical method.